Intra-arterial injection of dissolved Flunitrazepam tablets

Abstract

Intra-arterial application of dissolved tablets is associated with a high risk of tissue necrosis. An early active vasodilatating and recanalising treatment is necessary. We present the case of 21-year-old female who applied three dissolved Flunitrazepam tablets into the ulnar artery and was successfully treated with prostaglandin E1 and recombinant tissue plasminogen activator.

Good Clinical Outcome After Accidental Intra-arterial Injection of Flunitrazepam Tablets in 16 Drug Abusers with Critical Limb Ischaemia

“…A longer delay in treatment onset resulted in a high rate of borderline amputation, which confirmed other studies showing that early onset of therapy is a major determinant of good clinical outcome. 4,6,12,13 Moreover, in the study by Treiman et al 16 only 50% of the patients had a tissue ischaemia score of 3 or higher, as had all patients in our study. Three patients retained functional deficits and in 11 patients digital amputations were necessary, that is 30% had an unsatisfying clinical outcome, whereas in our study defects remained in only 19% of the patients.…”

“…The combination of both substances stops the pathophysiological cascade and ischaemic process. 6,7,14,18,20 PGE1 markedly enhances the fibrinolytic efficacy of rt-PA and does so, in part, by inhibiting platelet aggregation. 20 It has its own multiple beneficial effects on circulation.…”

Necrosis of the 4th and 5th Digits after Intra-Articular Injection of Diazepam into the Wrist

“…The optimal position may be the one that gives most pain relief, whether it is slightly lowering or elevating the hand. Thrombolysis (streptokinase [2], rt-PA [5, 15], and urokinase [16]) has been suggested in early stages and seems to show at least partial success in some cases …”

“…Vasodilatation using different substances (prostaglandins [5, 15, 17], papaverine [16], tolazoline [2], reserpine, or nitroglycerin [18]) is applied to address the vasospasm.…”

Akute Ischämie nach intraarterieller Drogeninjektion

“…Eine histologische Untersuchung nach Injektion von Temazepam Gel zeigte Muskelzellnekrosen, interstitielle Ödeme, ausgedehnte arterielle, venöse und kapillä-re Thrombosen und Endothelzellschwellungen (7). (6), intraarterielle Iloprost-Infusionen (11,14,18), intraarterielle Papaverininfusion (3), hyperbare Sauerstofftherapie (1) und Kombinationstherapien (2,5,13). Unter der Vorstellung, dass der Vasospasmus eine entscheidende Rolle in der Pathophysiologie der Ischämie spielt, wurden bei drei Patienten eine intraarterielle Applikation des Vasodilatators Tolazolin erfolgreich angewendet (17).…”